Updated IOL presentation Oct 2012

Annabel Jay
Senior Lecturer
University of
A qualitative study of women’s
experiences of labour induction
Why Study Induction?
• Much medical research, but women’s experiences poorly
explored in recent years
• Seminal work of Cartwright in 1970s
- women lacked information, choice and control
• BUT IOL remains a major source of verbal and written
complaints in some NHS Maternity Units.
• Verbal evidence suggests large discrepancies between
women’s expectations of induction and the realities they
Has anything changed since the 1970s?
According to the NICE guideline...
“Women who are having or being offered induction of labour
should have the opportunity to make informed decisions
about their care and treatment, in partnership with their
healthcare professionals” (NICE 2008 p4).
Healthcare professionals should:
• Allow women time to discuss induction before deciding.
• Encourage women to explore other sources of information.
• Encourage women to ask questions and consider various
• Support the woman whatever her final decision. (NICE,
What the literature says
• Shetty, Burt et al (2005)
– Need for more information and involvement in decisionmaking
• Westfall & Benoit (2004), Gatward & Simpson (2007)
-need for better information and choice
• Rice-Simpson, Newman et al, (2010), Gatward and
Simpson (2007)
– Suggest that targeted education (for planned IOL) may
improve women’s experience by enabling adjustment of
• NICE (2008), Gulmezoglu, Crowther et al, (2006)
– Call for more research into women’s experiences of IOL
Research questions:
• How do women expecting their first baby acquire
knowledge about induction?
• How does this impact on their decision making?
• How do does this affect their subsequent
experience of labour, birthing and early
• How does targeted antenatal preparation for IOL
affect women’s experience and perception of
Methodology and sample
• Situated within the context of current
discourse on informed choice
• 30 women
– Aim: approx 50% from pre-induction class
• Broadly phenomenological approach; semistructured, face to face interviews.
• First-time mothers
• Over 18 years of age and able to give
informed consent
• Able to speak, understand and read English
without assistance
Plan of investigation
Women approached on PN ward or IOL class
Information given, permission to contact sought
Contacted 3-4 weeks postnatally
Face to face, semi-structured interviews
conducted in women’s homes
• Audio recorded and transcribed
• Complete anonymity assured
• Full REC and R & D approval received
May/June 2012
Ethical issues
• Gaining access to participants
• Access to records
• Personal stance
– Midwife, mother, teacher, researcher
• Role conflict
• Responding to difficult situations
• Disengaging
Early themes
• Unexpectedly high rate of CS
• Limited perception of choice
– Acceptance of standard care plan
– Not always negative
• Unprepared for delays
– Boredom, anxiety, fear (including
– Exhaustion through lack of sleep
Early themes
• Need for specific information at time of
– Poor coverage in local AN classes
– Most information from media & friends
– Fear of knowing too much in advance
• IOL gives sense of control over labour
– Faith in clinical staff
– Fear of natural birth?
What women have said...
“..I just thought
that was the way
it went!”
“We sat
around for
the whole
“I have to do
what’s right for
the baby”
sleep at all (in)
24 hours”
”I need a little handout
to say “this will
happen now...this will
happen next”...I need
a little flowchart!”
“It was a big
relief to know it
was all being
Where to now?
• Continue data collection
• Commence formal analysis
– Thematic induction
• Access medical records to add
further layer of data
• Consider alternative ways of gaining
access to women from pre-IOL class

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